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�r � <br /> � <br /> m � x <br /> a � <br /> 9Hy <br /> H�3 <br /> y H ����'� ' v,m•ce:o,�sve�mu. <br /> K y � Date <br /> eiao oeo�• <br /> �N p� Appliwlion For <br /> yyr PUBLIC WORKS PERMfT "oero,w�ee"° 5 <br /> �L Z Luss Av01 Fce Pa�O 5 <br /> t� 0 � <br /> y rj Beunce oue g <br /> H� g Print or Type Only <br /> G�• o <br /> ��'� 1 wn�� 1l-�nnr� .���� `f73o C'r,11� ��•a Dh�d 1 �i ��i- �/�?PLi�e — <br /> H h <br /> Owncr Mailing Adtlress J ��Y Z P <br /> g�, <br /> �G❑ey f . r., . �ml�, � �, �� l�f� a_t1uwl��i� 9�aaS d59- /y>i <br /> 3 [•1 � Applic Mailing Adtlress City Zi�� Phone <br /> HO: y <br /> C�i� rM/P/ 1/`� 'Y!(.?i � ��P(w — �sri�dll Sr�9no� <br /> Describe Proposed Work , <br /> _. � <br /> Pwject Atldress�il known� Snr G ��� �� � <br /> � <br /> Attach�our I41�opies ol plans lor proposed work- Draw to scale and nole Ihe�ollowing as applicahle: � <br /> • Pioperty Lines • Cenledine ol streel <br /> • Outlme and dimensions ol all e�isting and • Indicate Norih <br /> pioposed simctures on Ihe lot • Show any proposed gradin9 r.hanges <br /> • Existin9 antl p�oposed utilltins • Show measurei-.om:: /'�� <br /> �_ W <br /> DO NOT WR�TE BE' OW THIS LINE O <br /> ' ' PERMIT CONDITIONS � <br /> ' � 1. All calls lo�inspec�i0n 5hall Ge made 24 hB.in ad��ance�phone 259•881 5. <br /> � p. All work shall be perlormed m ar,cordanee wilh this permit antl current City ol Everett Desipn and ConsUuciion <br /> Standards and Specilications. � <br /> '�' 3. Call Location Undcrqwund Service 48 hrs bclorc you Cig.TOLL FREE NUMBER 1-800-424•5555. <br /> 1-I � <br /> ��i <br /> P-1 . ,�-:,- �"" <br /> ,- <br /> y, ; �. -l' /_� ,..-c.-, �o <br /> �_I � f%_ � �_c,:�,:. � /���c- � <br /> I�P 0 <br /> ►_I a <br /> ►"1 <br /> ►I <br /> ACKNOWLEOGflh1[NT::� CONDITICiN;���. <br /> '� The ondersiBneJ owner/applicant hereby agrees to h..i�i„n.:�. .�'���„°? <br /> Iess the City ol Everell Irom any and all claims lo� d.n„��q���� ' � <br /> a� enpen5e5, or causes ol acfion that may arlse 6mv�:'..�� ��� ���:;.,i6n�cn <br /> and maintenance of Ihe improvement or other ri9M obv:ry ��.,�' �'��"'-'�° <br /> appiied for and turther agreos to removo same ��n�r� �'��"��" �«��� tnc <br /> App�oveA lor Constructinn ���� City and lo replace public p�operty damaged ihercUy <br /> FINAL INSPECTION Date U,t� <br /> Approved as Constru[led SignaWre of Applicant <br /> i.�.i,���� PUBLIC WORKS DEPARTMENT <br /> 80RD\STOFRDATE� PEFMIT ISEISSUED ANDBTHCR pp7D�N��1ii� <br /> � 3200 C=dar Street BE DILIGENTLY PURSUED TO COh1PLETInN. THIS °ERM111T A:AY f3[ <br /> [verett.WA 98201 C�NCCLLED 8V THE CITY UPOIJ ANY STOPPAGF OF VJOF+h nN THIS <br /> Phonc�. 259�0815 pROJECT OVFR 90 DAYS �U�AT�ON <br />